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Abscess-forming lymphadenopathy and osteomyelitis in children with Bartonella henselae infection
Regina Ridder-Schröter1, Aleander Marx2, Meinrad Beer3
1Children's Hospital, University of Würzburg, 97080 Würzburg, Germany.
Insights
Bartonella henselae causes cat-scratch disease (CSD). This study reports rare systemic CSD cases in immunocompetent children, including osteomyelitis, highlighting the need for vigilance.
Area of Science:
- Infectious Diseases
- Pediatrics
- Microbiology
Background:
- Bartonella henselae is the primary cause of cat-scratch disease (CSD), typically presenting as lymphadenopathy in children and adolescents.
- Systemic CSD infections are uncommon, predominantly occurring in immunocompromised individuals.
Observation:
- This report details four cases of CSD in children aged 6-12 years.
- Three children presented with abscess-forming lymphadenopathy and myositis; one developed osteomyelitis and an axillary lymph node abscess.
- Diagnostic methods included serology, eubacterial universal PCR, indirect fluorescence assay, and lymph node biopsy.
Findings:
- Three children received varying antibiotic treatments (erythromycin, cefotaxime/flucloxacillin), with one receiving no antibiotics, and all healed.
- The fourth child, diagnosed with osteomyelitis and lymph node abscess, successfully responded to a combination therapy of clarithromycin, clindamycin, and rifampicin.
- Immunodeficiency was ruled out in all patients.
Implications:
- Prolonged fever of unknown origin in children can indicate a systemic complication of CSD, even in immunocompetent individuals.
- Prompt diagnosis and appropriate antibiotic management are crucial for favorable outcomes in systemic CSD.
- These cases expand the understanding of CSD manifestations in immunocompetent children, emphasizing potential systemic involvement beyond typical lymphadenopathy.
Abstract:
Bartonella henselae is the agent of cat-scratch disease (CSD), a chronic lymphadenopathy among children and adolescents. A systemic infection is very rare and most of these cases are found in patients with immunodeficiency. Here, cases involving four children of 6-12 years of age are reported. Three of the children had an abscess-forming lymphadenopathy and surrounding myositis in the clavicular region of the upper arm. The diagnosis was made serologically and, in one case, using eubacterial universal PCR. One child was treated with erythromycin for 10 days, the second received cefotaxime and flucloxacillin for 14 days and the third child was not treated with antibiotics. The fourth child had a different course: a significantly elevated signal intensity affecting the complete humerus was found in magnetic resonance imaging, consistent with osteomyelitis. A lymph node abscess was also found in the axilla. Diagnosis was established by indirect fluorescence assay and lymph node biopsy. Antibiotic therapy using clarithromycin, clindamycin and rifampicin was gradually successful. Immunodeficiency was excluded. All described lesions healed without residues. In immunocompetent patients, infection affects skin and draining lymph nodes; however, prolonged fever of unknown origin as in the fourth patient indicated a systemic complication of CSD.
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